Sleep Troubles of Young Children Studied

Once upon a time, not very long ago, experts and lay people alike
tended to see post-toddlers and preteens as excellent sleepers.
Children in that age group exhibited neither the night wakings of the
diaper set nor the night-owl tendencies of those for whom the peer
group rules.

Over about the past 15 years, though, research has suggested that
the untroubled sleep of elementary-school-age children is something of
a fairy tale. They appear to suffer from some of the same sleep
problems as younger and older children, and many sleep researchers
suspect that, like Americans in general, they tend not to get enough
sleep.

Understanding more about sleep in the 5-to-11 age group has taken on
new urgency, too, because of the steep increase in the number of
children diagnosed with attention deficit hyperactivity disorder. ADHD
manifests itself in many of the same ways that inadequate sleep
does.

"Elementary-school-age children are probably the least studied in
terms of sleep," said Jodi A. Mindell, a professor of psychology at St.
Joseph's University near Philadelphia and the associate director of the
sleep-disorders center at the Children's Hospital of Philadelphia.
"There is more that we know today than 15 years ago, when we knew
nothing, but there is dramatically more that we don't know."

Campaign Under Way

One sign of the increased attention to the issue among policymakers
is the $4 million earmarked by the National Institutes of Health to
underwrite research into children's sleep disorders. The new grants
will build on earlier NIH-financed work that looked at a pediatric
condition called obstructive sleep apnea.

One of the first sleep problems to be studied extensively in
children of school age, obstructive sleep apnea refers to trouble
children have breathing during sleep because of enlarged tonsils or
adenoids.

The National Heart, Lung, and Blood Institute at the NIH has also
taken a lead in bringing the sleep needs of young children to public
attention.

In a five-year campaign launched last summer, an array of
organizations, including the National Association of Elementary School
Principals, endorses the idea that at least nine hours of good sleep a
night is critical for children to do their best in school and other
activities, to stay healthy, and to avoid accidents.

The campaign features Garfield, the popular cartoon cat, as its
"star sleeper."

"There's been accumulating evidence about the importance of sleep to
good overall health for all ages," said Dr. Carl E. Hunt, the director
of the NIH's National Center on Sleep Disorders Research.

"And there's been increasing awareness on the part of sleep
researchers that information about sleep is not known or appreciated by
the public," he added.

Marsha C. Egan, a school psychologist in the Liverpool, N.Y.,
district, couldn't agree more. In a survey of students, parents, and
teachers she conducted in two Liverpool elementary schools last year,
more than 20 percent of the 120 parents who responded said they did not
believe the amount of sleep their children got affected their school
performance the next day.

"That tells me there's an educational piece that should come into
play," she said.

Research suggests that elementary-school- age children who get
enough sleep, which ranges down from about 11 hours a night, do better
in school, are more contented, suffer fewer accidents, and are less
likely to become obese than children who don't get the sleep they need,
Dr. Hunt said.

Sleep Problems

Researchers point to a multitude of sleep-deficit effects on
children's moods, their ability to focus and think, and their
self-control.

"The primary thing the studies show got affected is mood," said Dr.
Judith A. Owens, who heads the pediatric-sleep-disorders clinic at
Hasbro Children's Hospital in Providence, R.I.

"Children more easily became frustrated, intolerant, irritable, and
oppositional [when they were short of sleep]. And there seems to be a
pretty consistent finding that attention span, reaction time, and
vigilance all suffer," she said.

Some school-age children simply aren't getting the sack time they
need. But others have trouble sleeping, problems often similar to those
that affect adults, though children were once thought to be exempt from
such woes.

Dr. Owens found that among almost 500 children attending
kindergarten through 4th grade in the Portsmouth, R.I., school
district, 37 percent had at least one sleep- related problem. The
prevalence of the problems in the study ranged from close to 4 percent
for disordered breathing to 15 percent for bedtime resistance.

And teachers reported a full 10 percent as being significantly
sleepy during the school day—almost certainly lower than the
total number of children affected, because youngsters often react to a
lack of sleep by becoming more active, rather than slowing down.

The picture may be even more worrisome for children at the older end
of the elementary span. Recent research by the psychologist Avi Sadeh
and others at Tel Aviv University in Israel suggests that 6th graders
are adopting the sleep patterns of teenagers, which are influenced both
by puberty and an increased number of late-night activities.

Teenagers naturally go to bed later and get up later, but they are
often unable to rise as late as they want, leading to sleep
deprivation.

In its study of 140 children in 2nd, 4th, and 6th grades, the
Israeli team also found a negative relationship between family stress
and sleep quality.

One of the most striking discoveries made by pediatric-sleep
researchers is that children diagnosed with attention deficit
hyperactivity disorder are more likely to have sleep problems than
children without that diagnosis.

While the phenomenon is not well understood, it raises the
possibility that some children will be diagnosed with ADHD when they
are short of sleep.

But Dr. Owens, who along with her work on sleep disorders runs a
program on learning, attention, and behavior at Rhode Island Hospital,
cautions that some sleep problems may be an intrinsic part of ADHD or
related to medications used to treat the disorder.

Many sleep specialists advise screening to detect sleep disorders
for children with behavior problems as well as for those who are
outright drowsy.

"Some children get labeled as ADHD who actually have sleep problems,
like apnea," Dr. Owens said, "and some have both sleep problems and
ADHD."

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